颈神经在keyhole入路后路经皮内镜下颈椎间盘切除术中的尸体解剖研究

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摘要目的通过模拟keyhole入路后路经皮内镜下颈椎间盘切除术，研究颈神经根与周围组织的局部解剖关系。方法选用6具福尔马林浸泡的成人尸体颈椎标本，模拟keyhole入路后路经皮内镜下颈椎间盘切除术，去除椎旁肌肉等软组织以暴露“V”点。以“V”点为中心，5 mm为半径设定keyhole范围。测量双侧C_3~4到C_6~7骨质厚度范围及keyhole范围内颈神经根与周围组织解剖关系。结果 C_3~4到C_6~7上位椎板下缘的骨质厚度、下位椎板上缘的骨质厚度、关节突骨质厚度的数值范围分别为5.11~5.69 mm、5.09~5.42 mm、7.15~8.81 mm。C_5~6和C_6~7硬膜显露的长度明显大于C_3~4和C_4~5；C₆和C₇神经根与硬膜间的距离明显大于C₄和C₅神经根；C_3~4至 C_6~7“V”点距硬膜距离各节段逐渐增加；C_5~6和C_6~7“V”点距神经根距离明显大于C_3~4和C_4~5节段；差异均具有统计学意义(P＜0.05)。结论本研究所描述的keyhole入路对于颈椎神经根减压是适合的。C_5~6和C_6~7应适当多去除“V”点外侧关节突骨质，以便更好避开硬膜及显露神经根。

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	许崧杰
	陈学明
	赵鹏
	景鹏
	刘丽
	高艳

关键词 ：解剖, 脊柱, 颈神经根, keyhole, 后路经皮内镜下颈椎间盘切除术

Abstract：Objective To provide detailed anatomical information for improving the keyhole approach of posterior percutaneous endoscopic cervical discectomy by cadaveric study of human cervical nerve roots.Methods Six cervical spine specimens from formalin-fixed adult cadavers were examined.The paravertebral muscles and soft tissues were removed to expose the V point.The keyhole was defined as a circle of 5 mm in radius with the V point as the center.The area of bone removal were measured bilaterally from C_3~4to C_6~7.Results From C_3~4 to C_6~7，the range of the thickness of bone removed from superior lamina，the thickness of bone removed from inferior lamina and the thickness of the bone removed in facet were 5.11~5.69 mm，5.09~5.42 mm，7.15~8.81 mm respectively.The length of the dural exposure at C_5~6 and C_6~7 was significantly longer than that at C_3~4 and C_4~5.The distance between C₆ and C₇ nerve roots and the dural was significantly greater than that at C₄ and C₅.From C_3~4 to C_6~7，the distance between “V” points and the dural gradually increased.At C_5~6and C_6~7 the distance between “V” points and the nerve root was significantly longer than that at C_3~4 and C_4~5.The differences were statistically significant (P＜0.05).Conclusion The keyhole approach described in this study is suitable for cervical nerve root decompression.At C_5~6and C_6~7，the lateral facet bone of the “V” point should be appropriately removed to avoid the dura injury and expose the nerve root easily.

Key words： anatomy spine cervical nerve root keyhole posterior percutaneous endoscopic cervical discectomy

通讯作者: 陈学明

作者简介: 许崧杰(1977－ )，男，副主任医师，首都医科大学附属北京潞河医院脊柱外科，stu_xusj@163.com

引用本文:

许崧杰，陈学明，赵鹏，景鹏，刘丽，高艳. 颈神经在keyhole入路后路经皮内镜下颈椎间盘切除术中的尸体解剖研究[J]. 实用骨科杂志, 2022, 28(7): 611-615.
Xu Songjie，Chen Xueming，Zhao Peng，Jing Peng，Liu Li，Gao Yan. A Cadaveric Study of Cervical Spinal Nerve Roots to Improve the Keyhole Approach of Posterior Percutaneous Endoscopic Cervical Discectomy. sygkzz, 2022, 28(7): 611-615.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I7/611

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